The Brown Longitudinal Obsessive Compulsive Study: Treatments Received and Patient Impressions of Improvement

Maria C. Mancebo, Ph.D.; Jane L. Eisen, M.D.; Anthony Pinto, Ph.D.; Benjamin D. Greenberg, M.D., Ph.D.; Ingrid R. Dyck, M.P.H.; and Steven A. Rasmussen, M.D.

Objective: The primary aim of this study was to assess the extent to which individuals with obsessive-compulsive disorder (OCD) received recommended doses of treatment and perceived a response to these treatments.

Method: Participants were 293 adults with primary OCD (DSM-IV) who were enrolled in the Brown Longitudinal Obsessive Compulsive Study, a naturalistic, prospective study of course in OCD. Data were collected at intake interviews between June 2001 and October 2004. Patient impressions of response to treatments received were assessed using the Clinical Global Impressions-Improvement Scale-patient version.

Results: Of the 182 participants taking recommended doses of serotonin reuptake inhibitors (SRIs) at intake, 112 (62%) rated themselves as being very much or much improved. The remaining participants rated themselves as minimally improved, unchanged, or worse while taking recommended doses of SRIs. These participants (N = 70) reported receiving their current SRI for a mean (SD) of 2.7 (3.2) years. Twelve (29%) of the 42 participants receiving neuroleptic augmentation of SRIs reported a response. Thirty-eight percent of the sample received the recommended number of 13 sessions of cognitive-behavioral therapy (CBT) lifetime. Only 24% reported completing a continuous course of 13 weekly sessions. Eighteen (67%) of the 27 participants who received a course of CBT in the past year rated themselves as very much or much improved.

Conclusions: In this large, naturalistic study of OCD, over one third of participants receiving recommended doses of SRIs did not perceive substantial long-term benefit from pharmacotherapy. Relatively few participants received recommended doses of CBT. Clinical implications and future directions are discussed.

(J Clin Psychiatry 2006;67:1713-1720)

Received March 29, 2006; accepted May 24, 2006. From Butler Hospital (Drs. Mancebo, Pinto, Greenberg, and Rasmussen) and Department of Psychiatry and Human Behavior, Brown University Medical School (Drs. Mancebo, Eisen, Pinto, Greenberg, and Rasmussen and Ms. Dyck), Providence, R.I.

Supported by a grant (R01 MH060218) from the National Institute of Mental Health, Bethesda, Md. (Dr. Rasmussen).

In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest (i. e., any proprietary entity producing health care goods or services consumed by, or used on, patients) occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: Drs. Mancebo, Eisen, Pinto, Greenberg, and Rasmussen and Ms. Dyck have no significant commercial relationships to disclose relevant to the presentation.

Corresponding author and reprints: Maria C. Mancebo, Ph.D., Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 (e-mail: maria_mancebo@brown.edu).